I want this to be a very private and special moment between my partner and I. We really don't want a stranger there. Why would I use a doula?

Rest assured that your doula will not be a stranger to you once you have hired her! You will become acquainted with each other during your prenatal visits and contact via phone and email, and you probably wouldn't hire her if you weren't comfortable with her. Don't forget, there will be many strangers at your birth once you get the hospital depending on your length of stay. Nurses, doctors, anesthesiologists to name a few. You may not even end up having your own doctor at your birth. With people coming and going throughout your labor, it is extremely comforting to know that the one constant besides your partner will be your doula who can keep you informed of what's going on.

What if I want some time alone with my partner? Will the doula get offended if I ask her to leave for a little while?

The doula wants the couple to have the best birth experience possible. During labor couples may need some privacy to regroup as a couple and get encouragement from each other, so the doula won't take offense if the couple needs alone time. Your doula can also make sure that no one else interrupts you unnecessarily during that time. After the baby is born I typically stay around until everyone gets settled in and mom and baby are fine, then I leave to give the new family their bonding time which is so important.

Why get a doula if the nurses and doctors will be there for us?

Without a doubt, nurses are usually wonderfully supportive, however, it is unusual for you to be their only patient. With the many demands placed on a nurse, she may not be there for you continually, and typically when she does come in it is to access you and baby and to record things on your chart. Nurses also change shifts, or bring in another nurse to lighten the load at times, so the chances of you having the same nurse throughout your entire labor is slim.

Your doula however, stays with you throughout your labor. One continuous presence. Even the doctor may not be the same one that you started with! Your doctor will only be called in occasionally and may not show up until you are pushing your baby out. Most doctors are very busy managing their business and manage your labor by phone, sometimes with more then one laboring woman at the same time.

What if I am planning on an epidural or decide to have one during my labor? Do I still need to use a Doula?

Doulas help you make informed decisions about your labor and birth options. This does not stop just because you decide on an epidural. Pain relief can be a real help in labor, but you still need to know the consequences of making that decision.

The dad or birth partner will still need support and relief, and during the often exhausting work of pushing, a doula can be valuable in lending a hand, offering suggestions, and in general helping you avoid intervention that you wouldn't experience otherwise such as forceps or vacuum extraction birth.

During your prenatal visits, your Doula will help you arrive at an informed choice and then fully support your decision. For instance, you may not know that most doctors won't let you have an epidural until you are 4-5 cm. dilated, or that epidurals can be patchy or may not work at all. You will want to know that most epidurals come with interventions that you may not have considered or wanted such as pitocin or c-sections. Again, your Doula can give you information you need to be more informed and offer alternatives, but will ultimately support your decision.

If your intention were to try for an unmedicated birth, and would use medication if things "get too bad", but would like to hold off as long as possible, your doula will help you get to 7-8 cm. comfortably before asking for pain relief. After hearing how far they are, which is an awesome accomplishment, they may actually opt to continue without medication!

What if I have a midwife, or am birthing at home? Won't having a doula be redundant?

A doula can still provide a valuable service, including personal childbirth educator and labor support. Midwives will take the place of the doctor, therefore their primary concern will be for you and your baby's safety and well being.

Having a doula there, ensures that you still receive that necessary emotional support you need during childbirth. Some midwives prefer to let the doula's handle that aspect of it so they can concentrate on the medical side of things. Talking to your caregiver is a good suggestion to get her input on it.

My family is planning on supporting me through labor. Why do I need a doula?

Your doula is not there to replace your loved ones, but to provide support to all of you. This is an emotional experience for all of you! She can bring drinks, food, relief, and moral support during labor. Often family members don't know how to help or what to do. The Doula can coordinate the efforts of the group by making them feel more useful. She may also help educate family members prior to labor, so that your family knows what your birth wishes are and what they can do to help.

What makes up a Doula's Fees?

Hours - Couples having their first baby may imagine that their doula will only be spending a few hours with them during the labor and birth. In reality, an eight-hour labor would be considered pretty fast. Most first labors last at least 24 hours or more. Typically, I'll spend around 13 hours average for labor and birth. Additionally, there are the hours spent in prenatal and postnatal visits along with emails, phones calls and travel time.

Clients - When I make a commitment to be available to attend your bith, I limit the number of clients I put on my calendar to avoid birth conflicts and to ensure that I am reasonably rested when you go into labor. When I put your due date on my calendar, I commit to being available to you two weeks beforehand and two weeks after that date.

Self-Employment Factor - The rule of thumb is that a self-employed professional's income is only half of what they earn, after deductions for things like taxes and business expenses. Communication expenses are high as well such as website, phone, and a computer with high speed internet connection. I also have typical professional and office supply expenses, and transportation expenses since I go to people's homes.

Training and Experience - It's important to me to keep up with the most current birth related information. In order to attend conferences and training opportunities, I often have to limit the number of clients I can accept around the time I will be unavailable, thereby reducing the number of clients I can work with each year.

Intangibles - Being on-call requires a very high level of personal sacrifice, including a willingness to be awakened after half an hour of sleep to attend a labor for the next 40 hours. Personal family events are frequently missed or interrupted for births. When I go to a movie with a friend, we have to take two cars, in case I have to leave suddenly for a birth. I can attend a party, but I'll have to forgo that glass of wine and I have to bring a change of clothes with me wherever I go. Thank goodness I LOVE this work!

Bottom Line - Nobody's getting rich doing doula work. But every doula should be able to make a decent living without making her life unbearable. I wish I could offer my services at a rate that everyone can afford, but that would require that I make even greater financial sacrifices than I am already making to do this work. There are people offering doula services that may be at significantly reduced prices by either offering less time and/or services, are still in training, or are in a financial position to do so. If you need the services of a free or low cost doula I can help you find someone; otherwise, it is a disservice to future birthing women by making labor support an underpaid profession that cannot attract or keep talented and skilled indiviuals. If you end up selecting a doula who is undercharging for her services, I strongly encourage you to pay her more than she is asking; otherwise, she may not be around for your next baby's birth. The most common cause of doula burnout is feeling overwhelmed by the commitment and undercompensated for one's time, expertise and dedication.

Advocacy Suggestions - Doula services are rarely covered by medical insurance plans, even though statistics prove that doulas can save insurance companies lots of money by reducing the use of medications, interventions, time in the hospital, and surgical (Cesarean) births. You can talk with your Human Resources representatives to ask them to lobby to include all doula services as a covered option in your plan. Also lobby your State legistature to include doula services in state-funded healthcare so that low-income women have access to experienced doula support and doulas don't have to further their financial burden by attending these births for free (which is what is done now). Additionally, you could talk to your midwife or doctor to encourage them to offer universal doula care to their clients. By hiring several doulas to be on-call for their clients, they could substantially reduce their cost per birth (and make their job easier) - although in this model the doula might be someone you've never met before. You could also advocate for the hospital to provide universal doula care, so that it would be covered in the same way as their in-house lactation consultants are covered. And by all means, tell everyone you meet about the support you received from a doula - spread the word about doula care so that more doulas are needed and are well paid and can continue their work for generations to come.

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